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THIS FORM IS TO BE COMPLETED BY THE OPERATING SURGEON AND MUST BE
RECEIVED BY ZIMMER BIOMET SHOULD A REVISION SURGERY BE REQUIRED WITHIN
TEN YEARS (10 YEARS) OF PRIMARY IMPLANTATION OF A PARTIAL OR PRIMARY
KNEE REPLACEMENT IMPLANT DUE TO THE ASEPTIC LOOSENING OF THE ZIMMER
BIOMET PARTIAL OR PRIMARY KNEE REPLACEMENT IMPLANT (HEREINAFTER
REFERRED TO “ASEPTIC LOOSENING”) WHERE THE ZIMMER BIOMET BONE CEMENT
USED IN THE PRIMARY IMPLANTATION WAS NOT INFUSED WITH ANTIBIOTICS, AS
OUTLINED IN THE BONE CEMENT WARRANTY TERMS AND CONDITIONS.

THE FORM MUST BE COMPLETED AND SUBMITTED TO BONECEMENTCLAIM@ZIMMERBIOMET.COM
WITHIN THIRTY (30) DAYS FOLLOWING THE REVISION SURGERY IN ORDER FOR
THE BONE CEMENT WARRANTY TERMS AND CONDITIONS TO BE EFFECTIVE.

Claim Form Instructions:

Step 1: Download and save the claim form to your device Step
2: Open the claim form from your saved location on your device and
complete the form within the interactive document Step 3:
Save, print, sign and send the form along with all supporting
documents and imagery to: bonecementclaim@zimmerbiomet.com

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intellectual property rights, as applicable, owned by or licensed to
Zimmer Biomet or its affiliates unless otherwise indicated, and must
not be redistributed, duplicated or disclosed, in whole or in part,
without the express written consent of Zimmer Biomet.

This material is intended for health care professionals.
Distribution to any other recipient is prohibited.

For product information, including indications, contraindications,
warnings, precautions, potential adverse effects and patient
counseling information, see the package insert and information on this
website. To obtain a copy of the current Instructions for Use (IFU)
for full prescribing and risk information, please call 1-800-348-2759,
press 4 for 411 Technical Support.

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